Concise Guide to Neuropsychiatry and Behavioral Neurology, 2nd edition (Concise Guides)

302 Pages·2002·1.65 MB·English

by  Jeffrey L. Cummings, Michael R. Trimble

CONCISE GUIDE TO
Neuropsychiatry and
Behavioral Neurology
Second Edition
CONCISE GUIDE TO
Neuropsychiatry and
Behavioral Neurology
Second Edition
Jeffrey L. Cummings, M.D.
Augustus S. Rose Professor of Neurology
Professor of Psychiatry and Biobehavioral Science
UCLA School of Medicine, Los Angeles, California
Michael R. Trimble, M.D., F.R.C.P., F.R.C.Psych.
Raymond Way Professor in Behavioral Neurology
Institute of Neurology
London, England
Washington, DC
London, England
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Books published by American Psychiatric Publishing, Inc., represent the views and opinions of the
individual authors and do not necessarily represent the policies and opinions of APPI or the American
Psychiatric Association.
Copyright © 2002 American Psychiatric Publishing, Inc.
ALL RIGHTS RESERVED
Manufactured in the United States of America on acid-free paper
06 05 04 03 02 5 4 3 2 1
Second Edition
American Psychiatric Publishing, Inc.
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Library of Congress Cataloging-in-Publication Data
Cummings, Jeffrey L., 1948–
Concise guide to neuropsychiatry and behavioral neurology / Jeffrey L. Cummings,
Michael R. Trimble.—2nd ed.
p. ; cm. — (Concise guides series)
Includes bibliographical references and index.
ISBN 1-58562-078-5 (alk. paper)
1. Neuropsychiatry. 2. Neurobehavioral disorders. I. Trimble, Michael R. II. Title.
III. Concise guides (American Psychiatric Publishing).
[DNLM: 1. Brain Diseases—physiopathology. 2. Mental Disorders—diagnosis. 3. Mental
Disorders—therapy. 4. Neuropsychology. WL 348 C971c 2002]
RC386 .C86 2002
616.8—dc21
2001058389
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
This volume is dedicated to D. Frank Benson, M.D.,
who guided our interest in neuropsychiatry,
and to all the students who find this small book sufficiently
tantalizing to pursue their own interests in neuropsychiatry.
This page intentionally left blank
CONTENTS
Introduction to the Concise Guides
Series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxv
1 Neuropsychiatric Assessment . . . . . . . . . . . . .1
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Clinical and Laboratory Examination. . . . . . . . . . . . . . . . . . 2
Initial Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Neuropsychological Testing . . . . . . . . . . . . . . . . . . . . . . 4
Neurological Examination. . . . . . . . . . . . . . . . . . . . . . . . 7
Formal Tests of Neuropsychological Function . . . . . . . . 7
Metabolic and Biochemical Investigations . . . . . . . . . . . 7
Electroencephalography . . . . . . . . . . . . . . . . . . . . . . . . 11
Brain Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
References and Recommended Reading. . . . . . . . . . . . . . . 18
2 Behavioral Neurobiology . . . . . . . . . . . . . . . .19
Neuroanatomy, Neurophysiology, and Neurochemistry . . 19
Essential Neuroanatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Limbic System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Basal Ganglia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Reticular Activating System . . . . . . . . . . . . . . . . . . . . . 28
Cerebral Cortex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Cerebellum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Brain-Behavior Relationships. . . . . . . . . . . . . . . . . . . . . . . 33
References and Recommended Reading. . . . . . . . . . . . . . . 33
3 Neuropsychiatric Symptoms and
Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Mania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Mood and Affect Lability . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Delusions and Psychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Hallucinations and Illusions . . . . . . . . . . . . . . . . . . . . . . . . 44
Anxiety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Obsessive-Compulsive Disorder and
Other Repetitive Behaviors. . . . . . . . . . . . . . . . . . . . . . . . 48
Personality Alterations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Dissociative Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Altered Sexual Behavior and Paraphilic Disorders . . . . . . . 53
References and Recommended Reading . . . . . . . . . . . . . . . 55
4 Unexplained Neurological Symptoms . . . . . .59
Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Nonepileptic Seizures or Pseudoseizures . . . . . . . . . . . . . . 64
Investigations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
References and Recommended Reading . . . . . . . . . . . . . . . 69
5 Frontal Lobe Syndromes. . . . . . . . . . . . . . . . .71
Frontal Lobe Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Dorsolateral Prefrontal Syndrome . . . . . . . . . . . . . . . . . 72
Orbitofrontal Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . 80
Medial Frontal Syndrome . . . . . . . . . . . . . . . . . . . . . . . 81
Frontal Lobe Dysfunction Associated
With White Matter Injury . . . . . . . . . . . . . . . . . . . . . . 83
Diseases of the Frontal Lobe . . . . . . . . . . . . . . . . . . . . . . . . 83
References and Recommended Reading . . . . . . . . . . . . . . . 85
6 Aphasia and Related Syndromes . . . . . . . . . .87
Hemispheric Specialization, Cerebral Dominance, and
Handedness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Aphasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Alexias and Agraphias . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Aprosodia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Amusia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Dysarthria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Mutism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Reiterative Speech Disturbances . . . . . . . . . . . . . . . . . . . . 96
Apraxia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Acalculia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Gerstmann and Angular Gyrus Syndromes . . . . . . . . . . . 100
Disconnection Syndromes . . . . . . . . . . . . . . . . . . . . . . . . 101
References and Recommended Reading. . . . . . . . . . . . . . 101
7 Visual, Visuospatial, and
Right-Brain Disorders . . . . . . . . . . . . . . . . . .105
Visuoperceptual Disorders . . . . . . . . . . . . . . . . . . . . . . . . 105
Monocular Blindness. . . . . . . . . . . . . . . . . . . . . . . . . . 107
Homonymous Hemianopsia . . . . . . . . . . . . . . . . . . . . 109
Achromatopsia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Cortical Blindness . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Simultanagnosia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Visual Discrimination Disorders . . . . . . . . . . . . . . . . . . . 111
Visual Recognition Disorders . . . . . . . . . . . . . . . . . . . . . . 111
Prosopagnosia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Environmental Agnosia . . . . . . . . . . . . . . . . . . . . . . . . 112
Visual Object Agnosia. . . . . . . . . . . . . . . . . . . . . . . . . 112
Color Agnosia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Finger Agnosia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Disturbances of Visuospatial Attention . . . . . . . . . . . . . . 114
Unilateral Neglect . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Anosognosia and Anosognosic Syndromes. . . . . . . . . 116